Inhibition of asparagine synthetase effectively retards polycystic kidney disease progression.
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Polycystic kidney disease (PKD) is a genetic disorder characterized by bilateral cyst formation. We showed that PKD cells and kidneys display metabolic alterations, including the Warburg effect and glutaminolysis, sustained in vitro by the enzyme asparagine synthetase (ASNS). Here, we used antisense oligonucleotides (ASO) against Asns in orthologous and slowly progressive PKD murine models and show that treatment leads to a drastic reduction of total kidney volume (measured by MRI) and a prominent rescue of renal function in the mouse. Mechanistically, the upregulation of an ATF4-ASNS axis in PKD is driven by the amino acid response (AAR) branch of the integrated stress response (ISR). Metabolic profiling of PKD or control kidneys treated with Asns-ASO or Scr-ASO revealed major changes in the mutants, several of which are rescued by Asns silencing in vivo. Indeed, ASNS drives glutamine-dependent de novo pyrimidine synthesis and proliferation in cystic epithelia. Notably, while several metabolic pathways were completely corrected by Asns-ASO, glycolysis was only partially restored. Accordingly, combining the glycolytic inhibitor 2DG with Asns-ASO further improved efficacy. Our studies identify a new therapeutic target and novel metabolic vulnerabilities in PKD.
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Acknowledgements: The authors are grateful to the other members of the Boletta laboratory for useful discussions. Technical help was provided by the core facility of Animal Histopathology, in particular A. Fiocchi, and the Animal Biochemistry core facility, in particular M. Raso and M. Ravà. This work was supported by the Italian Ministry of Health (RF-2018-12368254 to AB; GR-2016-02364851 to CP), the Italian Association of Patients with PKD (AIRP to AB), the Italian Association for Research on Cancer (AIRC, IG2019-23513 to AB). The authors are grateful to Dr. Silvia Bramani for her continuous support.
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1757-4684
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Fondazione AIRC per la ricerca sul cancro ETS (AIRC) (IG2019-23513)